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Infectious Diseases in Obstetrics and Gynecology
Volume 6, Issue 6, Pages 237-243
Clinical Study

Initial Multicenter Experience With Double Nucleoside Therapy for Human Immunodeficiency Virus Infection During Pregnancy

1Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
2Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Division of Maternal-Fetal Medicine, 8700 Beverly Boulevard, Suite 160W, Los Angeles, CA 90046, USA
3Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA
4Department of Obstetrics and Gynecology, University of Massachusetts Medical Center, Worcester, MA, USA
5Department of Obstetrics and Gynecology, University of British Columbia—Oak Tree Clinic, BC, Vancouver, Canada
6Department of Obstetrics and Gynecology, Dube University Medical Center, Durham, NC, USA
7Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, NC, USA

Received 5 September 1998; Accepted 25 November 1998

Copyright © 1998 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective: To study maternal and neonatal effects of combination nucleoside analog therapy administered to human immunodeficiency virus (HIV)-infected pregnant women for maternal indications.

Methods: A multicenter, prospective observational study was undertaken at six perinatal centers in the United States and Canada that supported regional referral programs for the treatment of HIV-infected pregnant women. Demographic, laboratory, and pregnancy outcome data were collected for 39 women whose antiretroviral treatment regimens were expanded to include more than one nucleoside analog for maternal indications. The 40 newborns were monitored at pediatric referral centers through at least three months of age to ascertain their HIV infection status.

Results: For all 39 women, zidovudine (ZDV) therapy was instituted at 13.4 ± 8.2 weeks, with a second agent (lamivudine [3TC] in 85% of cases) being added at a mean gestational age of 17.6 weeks. Duration of therapy with two agents was 20.6±10.4 weeks overall, with no women stopping medications because of side effects or toxicity. No significant changes in maternal laboratory values were seen, except for an increase in mean corpuscular volume, over the course of pregnancy. No clinically significant adverse neonatal outcomes were noted, with all but the three preterm newborns leaving hospital with their mothers. Neonatal anemia (hematocrit < 50%) was seen in 62% of newborns, with no children needing transfusion; mild elevations of liver function tests, primarily aspartate aminotransferase, were noted in 58% of newborns tested, though none were clinically jaundiced. Overall rate of neonatal HIV infection was 2.5% (95% confidence interval: 0.1–13.2%).

Conclusion: Combination antiretroviral therapy during pregnancy with two nucleoside analogs was well-tolerated by mothers and newborns, with no significant short-term toxicities or side effects noted. Surveillance of exposed newborns’ hematologic and liver function appears warranted.